The areas in which pacemakers have shown benefit continue to expand, while the design and function of pacemakers continue to improve. Following are some of the areas being explored:
Sleep apnea. Their role in correcting bradycardia (slow heartbeat) may make pacemakers effective for persons with sleep apnea. Sleep apnea is characterized by repeated, brief episodes of interrupted breathing during sleep. It can be due to the tonsils or tongue blocking the airway (obstructive apnea), or by the respiratory system itself (central apnea), where the nervous system slows down breathing too much when the body is at rest. By setting the pacemaker to make the heart beat at a slightly higher resting rate, researchers found that sleep apnea was improved. For reasons not understood, the pacemaker provided relief in obstructive apnea as well.
Falls in the elderly. Unexplained falls and blackouts in the elderly may not simply be due to aging. Rather, they may be a sign of unrecognized heart problems that could be corrected with a pacemaker. Recent research suggests that the use of a pacemaker in these patients may reduce the risk of blackouts or falls. Elderly individuals who suffer unexplained falls may find it helpful to see a cardiologist for testing.
Biatrial pacing. A new strategy to control the electrical activity of the atrium, biatrial pacing delivers electrical impulses to the right atrium and to the coronary sinus (the area of the heart that receives the cardiac veins and opens into the right atrium). Research suggests that biatrial pacing can reduce the number of episodes of atrial fibrillation.
Biventricular pacemaker. This new pacemaker designed specifically to treat congestive heart failure received approval from the Food and Drug Administration (FDA) in 2001. Also called a ventricular resynchronizer, this device uses an extra wire (lead) to synchronize the lower chambers of the heart so that they pump together. This therapy is called cardiac resynchronization therapy and has been shown to improve the pumping efficiency of the heart and reduce symptoms associated with heart failure. The resynchronizer is implanted in the chest in the same manner as a pacemaker. These pacemakers may be combined with a defibrillator.
Magnetic resonance imaging (MRI). Currently, MRIs are not possible for patients with pacemakers and other implanted devices because the electromagnetic fields generated to conduct the test can interfere with device functions. Scientists are examining potential methods of shielding devices during an MRI or creating wireless devices that would not be affected by the MRI’s magnetic fields. Such devices might temporarily take over some or all of the pacemaker’s functions while the pacemaker is turned off for the MRI test.
Transtelephonic monitoring. New methods of sending the data that pacemakers gather to physicians are also being examined. In October 2001, the FDA approved a new pacemaker that transmits data to a cell–phone like device carried by the patient. The phone sends the information to a customer service center, which then faxes it to the patient’s physician. This new form of transtelephonic monitoring differs from traditional checks because the data can be transmitted at any time and the process does not require patient involvement. It can be programmed to perform checks as often as needed, from once a day to once month. Current methods require that the patient call in every two to three months for a transtelephonic transmission of their pacemaker data.
Gene therapy. Studies are underway to develop a biological pacemaker that will vary its output to fit the body’s needs.
of the atrium, biatrial pacing delivers electrical impulses to the right atrium and to the coronary sinus (the area of the heart that receives the cardiac veins and opens into the right atrium). Research suggests that biatrial pacing can reduce the number of episodes of atrial fibrillation.
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